Hosetsu Namba (1760-1859), a practitioner at Kanagawa, Bizen (presently Okayama Prefecture) and a disciple of Rokujo Hanaoka, described in his Taisan Shinsho three cases of general anesthesia with Mafu- tsusan. They are breast cancer tumor excisions in two patients in 7 and 3 months of pregnancy, respectively, and anal fistulectomy in a patient in 3 months of preg- nancy. Their postoperative courses were uneventful, and all of them had smooth deliveries. Although Namba did not provide the exact dates of these opera- tions, it is highly likely that the patient with breast cancer in 7 months of pregnancy received the tumor excision during a period between 1815 and 1830. To the best of our knowledge, this is considered the first general anesthesia for surgery in a pregnant woman to be documented in the world literature.
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